A group of US and UK colleagues have published an interesting qualitative study about the challenges and resiliency of military mental health professionals (MMHPs). They had a small non-representative sample of British MMHPs who had completed a period of deployment in Iraq between 2003-2005. For the study, they participated in detailed interviews about their experiences practicing in a deployment setting. The authors did a nice job pulling together themes from the interviews in order to develop a conceptual model for the goals, challenges, and resources, and to draw out some recommendations about training and planning. Recommended:McCauley, M., Liebling-Kalifani, H., & Hughes, J. H. (2011). Military Mental Health Professionals On Operational Deployment: An Exploratory Study. Community Mental Health Journal. doi:10.1007/s10597-011-9407-8

A colleague pointed me to a Washington Post article describing an interactive suicide prevention video the Army has produced and will make mandatory for all soldiers. I experimented with the online demo of Beyond the Front, which shows scenes from the life two soldiers and allows the viewer to make choices that either lead toward or away from help and survival. The demo portion I reviewed focuses on the decision a distressed soldier faces in deciding to talk with the chaplain or not. I was impressed with the quality of the video and interested by the approach.

I am not expert enough in public awareness and mass media approaches to prevention to comment or speculate about how effective this video might be in preventing suicide in the Army. But I would like to comment on some intersections between the approach this video takes and some ideas about clinical practice.

To me, one of the most powerful aspects of this video is the way in which it leads the soldier-viewer to see him/herself as potentially at risk for suicide. The video gives the message "If you don't get help, your life could be in danger." Since the video is interactive, the viewer can actually make decisions (like keeping the distress or suicidal thoughts secret) that eventually lead to death.

From a clinical perspective, I have found that putting in front of a person--sometimes in a dramatic way--the danger he or she is in can actually help to kick in the person's survival instinct. It sounds strange to warn someone of danger when the danger is from oneself. But a question like this one can be sobering: "If there were nothing we could do to move life be more livable, how likely would you be to die?" I worked with someone who could not name a single reason why life could have worth or meaning and who could identify no chance for things to get better, but who, when asked that question, started talking about his son and two other people he wouldn't want to leave behind. Recently, I was pleased to hear a similar question encouraged in the ASIST approach to suicide prevention and intervention. An advanced variation of this question might even embed the prospect of hope within the danger question: "If there were nothing we could to help life be more livable--I think there are things, but let's say we didn't pursue them--If things continue like this, how likely would you be to die?"

It is strange and surprising to some clinicans that most people who are suicidal (and I would venture to say some who actually kill themselves) don't want to die. Many people who have survived near lethal suicide attempts have reported that. A participant in a workshop I gave several months ago illustrated this for me in a compelling way. This participant had, at an earlier point in her life, attempted suicide. She had since recovered and pursued education in the mental health field. In sharing her subjective experience of the suicidal wish, she said, "I never wanted to kill myself. I just wanted to kill the pain." What a gift. Clinicians should be aware of this and look for ways to simultaneously connect with the suffering and activate the part of every person that desires life.